The Tuskegee Case Study

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In your analysis of the Tuskegee Study, please ensure the following areas are addressed:
Using the Blanchard-Peale Three-Step model, identify significant questions of ethics and values raised by the Tuskegee Study.
Review the Belmont Report. The Belmont Report proposes three criteria for the evaluation of research using human subjects: respect for persons, beneficence, and justice. In what ways does the Tuskegee Study fail to conform to each of these criteria?
The Tuskegee victims were not informed about the nature of the study in which they were participants. A basic guideline for human subject research, specified in both the Nuremberg Code and the Belmont Report, is the requirement of informed consent. What would have constituted informed consent in the case of the Tuskegee Study? If such informed consent had been obtained from the subjects, would this remove all questions about whether the study was ethical?
Case Study Research Paper – Due Week 6
The topic has been provided. An annotated bibliography and outline is due in Week 3. Please refer to the Tuskegee Case Study Rubric for all guidelines and expectations.
The case study analysis should use APA format and be arranged as follows:
Cover page
Outline
Body of case study (six pages)
Personal opinion
References
Appendix A: supportive evidence (e.g., statistics)
Appendix B: means of gathering information
Tuskegee Syphilis Study
Brittany Daugherty-Brownrigg
The field of medicine has benefited tremendously from human research and
experimentation. Yet, these advances have come at a cost. There have been many
incidences in which individuals used in research studies were treated unfairly and
harmed. One historically relevant incident was called the Tuskegee Syphilis Study.
This federally funded study was initiated in 1932 in Macon County, Alabama by the
US Public Health Service to address the epidemic of syphilis.
Syphilis is a sexually transmitted disease caused by the bacterium Treponema
pallidum. Its symptoms often mimic other diseases making it hard to diagnose
without a specific blood test. It can be passed from person to person through
unprotected sexual relations and blood. The infection often goes unnoticed because
symptoms can be dormant. Although syphilis is easily curable, the infection can
cause significant problems if it remains untreated. There are three stages to the
infection: primary, secondary, and late or latent stages. The primary stage is
triggered by the presence of chancre sores. The secondary stage is reached when
there is the presence of mild skin rashes and lesions on mucous membranes.
The latent stage begins after the cessation of primary and secondary stage
symptoms. In some individuals, the latent stage never ends. However, approximately
15 % of individuals with untreated syphilis will go onto develop late stage
syphilis, which will bring additional health problems and may even be fatal.
Problems may occur within the lymph glands, vital organs, bone structure or central
nervous system.
Untreated syphilis in its late stage can cause neurosyphilis, an infection of the
central nervous system. Neurosyphilis can lead to symptoms such as blindness,
confusion, numbness, paralysis, dementia and difficulties coordination muscle
movements. Blood tests can be preformed to detect the bacterium that causes
syphilis. However, testing of the spinal fluid is a prime indicator of neurosyphilis.
B. Daugherty-Brownrigg (*)
John Carroll University, South Euclid, OH, USA
e-mail: bdaugherty10@jcu.edu
S. Loue (ed.), Mental Health Practitioner’s Guide to HIV/AIDS,
DOI 10.1007/978-1-4614-5283-6_90, # Springer Science+Business Media New York 2013
423
The only treatment for syphilis is penicillin or other antibiotics for individuals
allergic to penicillin. Follow-up blood tests and lumbar punctures may be
performed to monitor the progression of the infection and the effectiveness of the
treatment.
All of the study subjects in the Tuskegee Syphilis Study were poor Black
sharecroppers. They were not told that they were the subjects in a natural history
study of syphilis or that they were infected with syphilis. Instead, they were
informed that they were to be treated for “bad blood,” a euphemism that referred
to a variety of maladies including anemia, syphilis and others. The standard of care
for syphilis at the time the study began, 1932, consisted of injections of arsenic and
mercury for a period of 1 year. Later, following the discovery of penicillin, the
infection was treatable with this antibiotic. Nevertheless, the men were not
provided with the standard of care that prevailed for syphilis during the course of
the study and were actively prevented in some cases from obtaining treatment for
the infection from providers outside of the study. The incentives for continuing to
present for the ostensible treatment included free physical examinations, free
transportation to and from clinics, hot meals and a guaranteed burial stipend.
However, there was no official protocol for the experiment and the men were
simply being tested for the complications of the disease instead of being treated.
During this time racial tension was prevalent in the South. This set a dramatic
tone for the way this cohort of Black men was treated. Scientists and physicians
emphasized differences between Whites and Blacks in their facial features, skin
color, cranium and brain size as a means to both explain and justify their portrayal
of Blacks. African American subjects were portrayed as inferior on many different
levels. Black sexuality was equated to what was perceived as Blacks’ innate sexual
promiscuity a character flaw that was inherently problematic.
During the 1960s, questions began to be raised regarding the ethics of the
Tuskegee Syphilis Study. An investigation of the study ultimately led to its cessation
in 1972. No longer can researchers use human beings as merely a means to an
end in the conduct of research. Since the Tuskegee Syphilis Study, laws have been
promulgated to protect participants from harm. Prospective study participants must
be provided with adequate information about the study objectives as well as the
risks and benefits associated with participation; this information constitutes
elements of what is known as informed consent. Additionally, their consent to
participate must be voluntary, unlike that of the men in the Tuskegee Syphilis
Study, who faced the possible loss of their employment if they refused to
participate.
Many institutions that conduct research have established committees to review
the ethical aspects of a study prior to its approval and conduct. These are known in
the USA as Institutional Review Boards (IRBs) and in many other countries as
Research Ethics Committees (RECs). These committees review the risks and
benefits of proposed research to ensure that the protocol complies with international
and national standards for the conduct of research with human beings. In the USA,
the federal agency of the Office of Human Protections, established by the US
424 B. Daugherty-Brownrigg
Department of Health and Human Services, focuses on the protection of human
research participants.
This study exemplifies the exploitation of Blacks by researchers and medical
professionals; the study led to injury to the men’s bodies and displayed utter
disregard of their rights as patients seeking care. Importantly, the study has led to
the distrust of medical “establishments,” which helps to explain not only the
reduced involvement of African Americans in clinical trials, but also their greater
reluctance to seek HIV testing and to seek out and utilize medical and behavioral
health services if HIV positive. In a widely cited 1991 analysis, Thomas and Quinn
suggested that the enduring power of intra-community memory of the infamous
Tuskegee Syphilis Study within the African American community has significant
impact on trust of medical institutions and, therefore, the effectiveness of HIV
prevention programs designed and delivered by those institutions. Bogart and
Thorburn (2005) found significant endorsement of conspiracy theories about the
origin of HIV/AIDS among African Americans, and a strong association between
the acceptance of conspiracy theories and a distrust of and reduced use of condoms
among men. In an abstract presented at the 2004 AmFAR National Update Conference,
Nessel and Primm of the Addiction Research and Treatment Corporation
reported having found high levels of distrust of medical institutions among
individuals from groups who were surveyed about the origins of HIV.
Related Topics: African Americans, cognitive impairment, conspiracy theories,
denialism, discrimination, informed consent, sexually transmitted infections.
Suggested Reading
Bogart, L. M., & Thorburn, S. (2005). Are HIV/AIDS conspiracy beliefs a barrier to prevention
among African Americans? Journal of Acquired Immune Deficiency Syndromes, 38(2),
213–218.
Foster, C. (2001). The ethics of medical research on humans. New York, NY: Cambridge
University Press.
Jones, J. H. (1981). Bad blood: The Tuskegee syphilis experiment. New York, NY: The Free Press.
Thomas, S. B., & Quinn, S. C. (1991). The Tuskegee Syphilis Study, 1932–1972: Implications for
HIV education and AIDS risk reduction programs in the black community. American Journal
of Public Health, 8(11), 1498–1504.
Washington, H. A. (2006). Medical apartheid: The dark history of medical experimentation on
black Americans from colonial times to the present. New York, NY: Doubleday.
Suggested Resources
Centers for Disease Control and Prevention. (2010, September 16). Sexually transmitted diseases:
Syphilis–CDC fact sheet. Retrieved January 30, 2012 from http://www.cdc.gov/std/syphilis/
stdfact-syphilis.htm
Tuskegee Syphilis Study 425
Centers for Disease Control and Prevention. (2011, June 15). U.S. Public Health Service Syphilis
Study at Tuskegee. Retrieved January 30, 2012 from http://www.cdc.gov/tuskegee/timeline.
htm
Office of Human Research Protections. U.S. Department of Health & Human Services. http://
www.hhs.gov/ohrp/index.html
PubMed Health. (2010, September 15). Neurosyphilis. Retrieved January 30, 2012 from http://
www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001722/
426 B. Daugherty-Brownrigg

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